Be aware of changes, effective immediately, to wound definitions and stages. The changes were announced April 8 and 9 by the National Pressure Ulcer Advisory Panel (NPUAP).
 
Among the changes, the term “pressure injury” will replace “pressure ulcer” and Arabic numbers will now be used in the names of the stages instead of Roman numerals. That’s in line with changes made in OASIS-C2.
 
Also, the term “suspected” has been removed from the Deep Tissue Injury diagnostic label and the panel agreed upon additional pressure injury definitions including those related to Medical Device Related Pressure Injury and Mucosal Membrane Pressure Injury.
 
These changes were presented at a Chicago meeting of over 400 professionals, according to an April 13 NPUAP release.
 
Changes to staging
 
Among the most noteworthy changes to staging is the clarification made to Stage 2 pressure ulcers, says Brandi Whitemyer, product specialist for DecisionHealth in Gaithersburg, Md. NPUAP indicates these wounds cannot have granulation, slough or eschar. Clinicians often mark a shallow Stage 3 pressure ulcer with slough or eschar as a Stage 2 on the OASIS responses only because it is not that deep. This is a costly mistake that could cost agencies up to $500 an episode, Whitemyer says.
 
Agencies should reinforce that clinicians should never mark an ulcer with slough or eschar as anything lower than a Stage 3 if those are present in the wound bed, she adds.
 
More details on wound changes
  • Pressure injury. The change to pressure injury more accurately describes pressure injuries to both intact and ulcerated skin, the release explains. In the previous staging system, Stage 1 and Deep Tissue Injury described injured intact skin while the other stages described open ulcers. This led to confusion because the definitions for each stage referred to the injuries as “pressure ulcers.” The term “injury” is more accurate, as not all pressure injuries result in a break in the skin or ulceration. Their true nature is an injury related to consistent pressure from external force in conjunction with internal forces of bony prominences causing compression of the vasculature to the area and resulting tissue damage, Whitemyer says.
  • The removal of the term “suspected” from deep tissue pressure injuries is a more accurate description of the wound, Whitemyer says. When these are present, there is evidence of a wound present, not suspicion of one. Such injuries are reportable on claims and should be treated with active pressure relief interventions to assure they do not result in opening of the epithelium over the area of tissue injury, which may lead to a progressively worsening pressure injury, she adds. Previously these were reported as “SDTI” or suspected deep tissue injury in evolution.
  • New terms for mucosal membrane pressure injury and medical device-related injury are added. These provide clearer and descriptive terms for the cause of many pressure-related injuries. Clinicians should remember medical device-related pressure injuries need to be staged as well but these do commonly occur with durable medical equipment, such as prosthetic devices for the leg, Whitemyer says.
  • Mucosal membrane injuries. These also are related to the use of a medical device when resulting in pressure injury in the area of mucosal membrane. They are not staged, and clinicians should remember that according to OASIS guidelines, mucosal membrane wounds are not reportable in any OASIS M items, even M1350 (Does this patient have a skin lesion or open wound, excluding bowel ostomy, other than those described above, that is receiving intervention by home health). They should still be clearly documented and assessed in the comprehensive assessment and plan of care, Whitemyer says. 
Related links: For the full press release, click here:http://homehealthline.decisionhealth.com/Articles/Detail.aspx?id=521735. View schematic artwork reflecting the changes in stages for pressure injury at: http://bit.ly/1p0NMaE.
 
Editor’s note: For training on this new guidance, attend the National Quality Outcomes & OASIS-C conference Sept. 19-22. For more details, visit: www.homecareoutcomesconference.com.